2025 CPT code 95165
(Active) Effective Date: N/A Revision Date: N/A Medicine - Allergen Immunotherapy Services and Procedures Medicine Services and Procedures > Allergy and Clinical Immunology Procedures Feed
Supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses).
Modifiers 25, 52, 53, 76, 77, 79 may be applicable depending on the circumstances.Consult your payer's guidelines for specific modifier usage.
Allergen immunotherapy is medically necessary when a patient has significant allergies that are not adequately controlled by other means, such as avoidance or medication.The decision to use immunotherapy should be based on proper allergy testing and clinical judgment.
The physician is responsible for supervising the preparation of the allergen extracts, ensuring proper dosage and safety. This includes oversight of the preparation process, not necessarily direct participation in the mixing.
In simple words: This code covers the doctor's work in overseeing the preparation of allergy shots. The doctor makes sure the right amount of medicine is prepared for each shot, whether it's one shot or several.
This CPT code encompasses the professional services involved in supervising the preparation and dispensing of antigens for allergen immunotherapy.The code covers both single and multiple antigen preparations. The exact number of doses prepared must be specified when billing.
Example 1: A patient with seasonal allergies to ragweed undergoes allergy testing, and the allergist orders a series of immunotherapy injections. The allergist's staff prepares the vials of antigen under the allergist's supervision using code 95165.The allergist specifies the number of doses included in the vial preparation in the claim., An allergist prepares a multi-dose vial of antigens for a patient with multiple allergies (grass, dust mites, and cat dander). The vial contains enough for several injections. Code 95165 is used, with the total number of doses indicated., A physician prepares a single vial containing a sufficient number of doses for a 12-month supply, in compliance with CMS guidelines. Code 95165 is used, with the number of doses clearly reported.
* Patient's medical history, including allergy testing results and the specific allergen(s).* Physician's orders specifying the type and amount of antigen to be prepared for immunotherapy.* Documentation of the preparation process, including the number of doses prepared.* Verification of the physician's direct supervision of the preparation process (if prepared by auxiliary personnel).
** Direct supervision by the physician is required if the antigen preparation is performed by auxiliary personnel.Ensure compliance with CMS guidelines regarding reasonable supply limits (generally 12 months).
- Revenue Code: M5D (SPECIALIST - OTHER)
- RVU: This information is not available in the provided sources.Consult the current CPT codebook or your payer's fee schedule for RVU information.
- Global Days: The provided sources do not specify a global period. This would depend on payer-specific guidelines and the overall treatment plan.
- Payment Status: Active
- Modifier TC rule: The provided sources don't explicitly state whether a TC modifier applies.This should be determined based on your payer’s guidelines.
- Fee Schedule: This information is not included in the provided data. Consult your payer's historical fee schedules.
- Specialties:Allergists/Immunologists
- Place of Service:Office, Outpatient Hospital